Johnnie Collier, 71, recently went to Mercy Care’s downtown Atlanta facility to have a tooth extracted. He said it had been hurting him for many years.
Another patient, David Perlete, 63, who is uninsured, also had a painful tooth pulled there. Other facilities charge hundreds of dollars, he said.
Despite the work of charity clinics like Mercy Care, millions of older adults are unable to get the dental services they need.
Traditional Medicare, the federal health insurance program for people 65 and older and the disabled, does not cover routine dental treatment. (Some private Medicare Advantage plans do offer some coverage.)
The VA, which provides a wide range of medical care to millions nationwide, provides dental care to only a few, very limited categories of veterans.
Medicaid for adults in Georgia covers only extractions, said James Peeples, a Mercy Care dentist. And he tells patients to get them done in time and not to wait until they need a root canal.
“Unfortunately, extractions have become a way of life for many of the older patients we see,” Peeples said.
A State of Decay, a report released last month by Oral Health America, describes a shortage of oral health coverage, a strained dental health workforce, and deficiencies in prevention programs across the nation. The report said the highest-ranking state for dental health is Minnesota, with a 92.9 percent score, while the lowest is Mississippi, with 29.3 percent.
Georgia, which has no dentist in 24 of its 159 counties, got an overall score of 62.4 percent, and was ranked “fair.”
Dental health is an important part of overall health. Experts agree, for instance, that a tooth abscess left untreated can lead to serious, even life-threatening, complications.
Among Georgians 65 years and older, almost one in four have lost all their teeth, according to the CDC’s State Oral Health Profile.
Short shrift for oral care?
“Georgia’s dentists have a grave concern about the elderly population in our state and the lack of safety net programs for oral health,” said Nelda Greene, the Georgia Dental Association’s interim executive director.
“We have some very good pro bono programs,” said Greene, “but it doesn’t take care of all needs and it is not a sustainable health care delivery system.”
“It comes down to funding,” she continued, and dental care gets low priority.
“It’s as if we cut off the oral cavity from the rest of the body,” she said. “If a senior citizen falls and breaks their arm, their health care needs are taken care of with medical benefits. Not so with oral health issues. And going to emergency rooms will not solve the problem of an abscessed tooth.”
People who can’t get regular dental care often wait until the problem becomes unbearable, then head to the emergency room. Because the ER is the only recourse many of them are familiar with, it has become the “go to” site for everything from serious tooth decay to a lost filling.
In 2007, 60,000 emergency visits for non-traumatic dental problems or other oral health matters occurred in Georgia, at a cost of $23 million, according to the Pew Center on the States.
The Georgia Dental Association’s Mission of Mercy has helped many patients in dire need of oral care at their clinics. One was held this year, and the next is planned for 2015.
In addition, there are clinics such as Mercy Care. It provides some help for underserved patients in the Atlanta metropolitan area, based on a sliding scale to help cover costs.
Mercy Care Clinic’s manager, Denise Leon-York, said, “Older patients we get typically forgo dental work, because it’s not covered by Medicare.” When such people don’t get care promptly, the situation gets much worse, and they finally have to seek help.
The organization offers preventive, surgical, restorative and prosthetic services to people with low incomes, the homeless and HIV-positive clients.
“The older patients we see are at risk of a number of problems,” said Luis Limeres, a Mercy Care board member. The organization offers preventive, surgical, restorative, and prosthetic services.
“The problems from these patients can range from dry mouth caused by reduced saliva flow as a result of medications or cancer treatments to root decay caused by acids.”
Limeres continued, “Some patients have gum disease from plaque, poor diets, poorly fit dentures, and certain diseases like anemia and diabetes.” Some of the problems have been left untreated for extended periods of time.
“It is very hard for these patients to decide whether to replace a 20-year-old denture or take care of bills they have,” Limeres said.
Most retired Americans have no dental insurance.
A controversial proposal
CDC data show major disparities exist among dental care for residents of long-term care facilities, home-bound patients, and non-institutionalized adults.
To increase access to dental care in Georgia, an upcoming legislative proposal would allow dental hygienists in safety net clinics to provide care under the supervision of a dentist without the dentist being physically present.
Currently there are two notable exceptions where a dental hygienist does not need a Georgia dentist to be present — a Department of Public Health program and in a Department of Corrections facility, the Georgia Council on Aging says.
According to the council, Georgia is one of only five states in the country that require direct supervision of a dental hygienist by a dentist. The effort to give more latitude to dental hygienists has been a touchy political issue in Georgia.
The dental association’s Greene, asked about the proposed legislation, said, “The Georgia Dental Association believes a team approach is best for patients.”
“Dentists have the most education and training and are the oral health professional [and they] can examine and diagnose signs of oral cancer, gum disease or other health issues,” she said.
Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.